Facts about North Carolina Medicaid Managed Care

Published 5:56 pm Tuesday, May 4, 2021

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Most people in NC Medicaid must choose a health plan as part of the state’s transition to NC Medicaid Managed Care. Some people will stay in NC Medicaid Direct, and others will be able to choose whether they move to a health plan or not.

This Fact Sheet outlines who must choose a health plan, who may choose a health plan, and who cannot choose a health plan.

You may receive information from your health care provider encouraging you to choose a health plan they are contracted with in NC Medicaid Managed Care so you can continue being their patient. Communication from providers is not an official enrollment notice. Depending on your current eligibility, you may not be required to choose a health plan.

For questions, including whether you need to enroll, call the NC Medicaid Enrollment. For questions, including whether you need to enroll, call the NC Medicaid Enrollment Broker Call Center at 833-870-5500 or visit ncmedicaidplans.gov.

Who Must Choose a Health Plan?

Mandatory – Most families and children, Children receiving NC Health Choice, pregnant women, and people who are blind or disabled and not receiving Medicare.

Who May Choose a Health Plan?

Exempt – Federally recognized tribal members or others eligible for services through Indian Health Service (IHS), People with significant behavioral health needs, intellectual/developmental disabilities (I/DD), traumatic brain injury (TBI) and substance use disorders.

Who Cannot Choose a Health Plan?

Excluded – People receiving Family Planning Medicaid only, people who are medically needy, people participating in the Health Insurance Premium Payment (HIPP) program, people participating in the Program of All-Inclusive Care for the Elderly (PACE), people receiving Refugee Medical Assistance, children in foster care, children receiving adoption assistance, children receiving Community Alternatives Program for Children (CAP/C) services, people receiving Community Alternatives Program for Disabled Adults (CAP/C) services, people receiving Medicaid AND Medicare, people receiving Innovations Waiver services, and people receiving Traumatic Brain Injury (TBI) Waiver services.